The time to discuss how a person wants to die should take place long before that person is very ill, according to three speakers who led an interfaith program on palliative, hospice and spiritual care.
About 50 chaplains, rabbis and other clergy members who guide patients through their end-of-life decisions attended a three-hour workshop March 12 at the Smith Kogod Residence in the Charles E. Smith Life Communities where they were told that people in their 60s are adults and those 90 years and older are geriatric.
While living longer has its plusses, it can come with plenty of minuses. As people live longer, “they are taking diseases to a new stage” not seen before, said Dr. Elisa Gil-Pires, medical director at Charles E. Smith Life Communities. Dementia is becoming a normal part of old age. “It is a natural deterioration of the brain. It will come,” she said.
With palliative care, health care professionals talk directly to a patient when the first signs of illness arise. Palliative care focuses on relieving and preventing suffering and focuses on the person and family, not the disease or condition. “That’s the key,” Gil-Pires said.
When a 60-year-old shows signs of heart trouble, but doesn’t yet require surgery or even medication, that is the right time to talk about quality of life, Gil-Pires said. As symptoms grow worse, talk should center on what a patient should expect and how they want to deal with their increasing medical care.
“The focus here is not to extend his life but to make every day the best we can for him,” Gil-Pires said.
It’s important to show a dying person and the whole family “when a cure is no longer possible” that it’s time to strive for a peaceful life, said Simeone Frost, a nurse and director of education at Jewish Social Service Agency.
When a person near death is asked if they want hospice, they often say they aren’t ready, she said. But when those same people are asked well in advance if they want to die at home or in a hospital, they are more likely to say they want to be at home. And when they are asked if they want to prolong their life at all costs, they rarely say yes.
Hospice care, which often takes place in a person’s own home, is about comfort and relief of symptoms. It is not about prolonging life, Frost said. A person must have a prognosis of six months at most to be accepted into the hospice program and that is often long past the time when meaningful conversations can take place, Frost said.
The average hospice stay is short, she said — “just two weeks.”
Patients who are scared and in pain are in no condition to meet death, said Montgomery Hospice Chaplain Rev. Lynn Sifrit. A person coming to terms with their own mortality may be in “spiritual distress,” he said. They may be angry or feel hopeless and upset with their loss of control over their life.
Besides worrying about their health, patients who are dying often don’t know how but still want to reconcile bad relationships, he said. Often, they are trying to come to terms with God or religion, Sifrit said.
“Palliative care brings comfort. Spiritual care should too,” he said.